THE YOUNG PATIENT
Jennifer was getting ready to go on a hot date on a Friday evening. She was a cheerleader for the football team and one of the players, Rich, had asked her out to the movies. She was in the shower and was applying soap to her body and when she reached her neck, she again noted some lumps; they have been present for about one week and she had not paid much attention to them. She also felt some in the armpit on the right side. She was beginning to worry and thought it odd. She didn’t dwell on it because she had more important matters to attend to. That evening, she wanted to make a good impression on her date. She was seventeen, a senior in high school and he was the same age. She was very happy that he asked her out. She always liked him but felt he did not notice her. Some other boys had asked her out, but she always wanted Rich. So, this was a special night. She wanted to please him. At the same time she did not want to make it so obvious that she liked him, lest he got the wrong impression about the kind of girl she was. She took her time to dress up and look nice. He was supposed to pick her up at seven and she made sure she was ready at least half an hour before. The understanding was that they would go for ice cream after the movies. She had to be back at home at 11PM. Her mother was strict; her father had passed away a few years ago from lung cancer. He was a chain smoker. She didn’t mind being back at 11PM. She did intend to have a good time with Rich all the same.
At five minutes to seven, Richard rang the doorbell with a large smile. “Hello Jennifer, you look super,” he greeted her and gave her a peck on the cheek. He was fit, and he wore a pair of jeans, sneakers and a sweater. The musk of his cologne wafted in the air. He wanted to make a good impression.
“Hi, Rich. Thanks,” she replied, flattered and “let me introduce you to mom.”
“Mom, this is Rich.”
“Good evening, Mrs. Edwards.”
“Good evening and nice meeting you.”
Jennifer put on her coat. “We must get going. See you later mom,” as she kissed her mother goodbye.
“Have a good time and remember to be back at 11PM.”
“Goodbye Mrs. Edwards. I will bring your lovely daughter back safe and sound. I will be a gentleman.”
That he was. A bit shy during the movie, it took him a while before he attempted to kiss her. And when he did, she finally felt the ice melting and the evening got better from then on. After the movie, they went to an ice cream parlor, they hung out for a while, they saw other couples and were seen and as a rule the following Monday at school, everybody will know who went out with whom… Welcome to the world of teens where the superficial is very much in vogue, fashion is fleeting, taste varies from one minute to the next. It is a world where everyone feels youth will last forever, the hormones are surging and exploration of the sexual world is at its beginning and due to the newness of it, there is a new convert’s zeal and a naivete never to be found again later in life.
At the ice cream parlor, plenty of petting and kissing went on; one would feel out of place if not engaged in the same behavior. It was exhilarating, exciting and fun. Life was great! Jennifer and Rich had a good time together, as other teens did. It was the beginning of a relationship that both hoped would last as long as possible; at least for the evening that was the understanding. Finally, he reluctantly brought her back home at five to eleven and he kissed her goodbye; it was the longest kiss of the evening because it was hard to part company. As of this evening, they have started going together. She felt good and had a flushing sensation just thinking about it.
“Luv u,” Rich texted to Jennifer.
“Me 2. I had a great time tonight. Can’t wait to do it again.” Thus, the two teens went on back and forth texting before falling asleep. An infatuation had started.
When she went to sleep, she expected to have some pleasant dreams about the date because there was so much to reminisce about; this was after all her best date in a long time, if not ever. Therefore, when she climbed into bed, it was with such expectation; instead, she developed a fever and had some difficulty falling asleep. She had plenty of night sweats. The following day, a Saturday, before eating breakfast, she approached her mom. “Mom, I had a terrible night. I had fever and I have been noticing these lumps.”
Alarmed, the mother checked, and her facial expression quickly changed from a jovial to concerned one. “You have enlarged lymph nodes,” exclaimed her mom with an exasperated tone in the voice and “we need to make an appointment with the doctor ASAP.” Her mom had a frown on the face and kept tugging at her ear, the best clue she was worried and nervous.
Jennifer did not have the foggiest idea what the first part meant, but she very much understood the next part of the sentence.
“Hello Dr. Nebley, this is Mrs. Edwards, I want to bring Jennifer today. She has high fever and enlarged lymph nodes in the neck and armpit,” with a voice betraying the alarm bell ringing in her head. And turning toward Jennifer, “the doctor will see you in one hour. Go get ready.”
Getting ready, she did. “I am going to the doctor,” she texted to Rich.
“Why? What is going on,” he responded.
“I had fever last night and I also have some lumps in the body. My mom called them enlarged lymph nodes. I am scared.”
“Hopefully everything should be OK.”
“I hope so. I will tell you what happened later. Love you.”
No answer. Odd, she thought.
“Darling, everything will turn out OK,” her mom said half convincingly.
Jennifer’s dander was up; she knew her mom did not get alarmed for innocuous stuff. For her to insist on a same-day appointment was significant. Jennifer started becoming anxious, sensing that something was not right.
The doctor did a careful exam and asked a lot of questions and had an assistant draw quite a bit of blood. “I should have all the results by Tuesday the latest,” he reassured both.
On her way back home, “I saw the doctor and he ordered a bunch of tests for me. Results should be available by Tuesday,” she texted to Rich again. Still no immediate answer. In fact, no answer came until a few hours later. “I missed your text. I was at a workout. I will call you later.”
A cold text, she thought. She would mention it to him later when he would call, she decided.
“What kind of cold text was that?” she asked him later.
“I was rushing up to catch the school bus after the workout. I am sorry, I will make it up to you when we go out again on Friday.”
She was on pins and needles while waiting for the result of the tests. The fever came back for the next two nights. This was beginning to be a pattern she did not like. She chose not tell her mom.
Around midday the following Tuesday. “Good morning, Mrs. Edwards, this is Dr. Nebley. The results came back and I am happy to announce that quite a few diseases were excluded such as Infectious Mono, aka ‘kissing disease,’ and other infections, including HIV. However, there is a lot of inflammation going on. A biopsy needs to be done. We must eliminate the possibility of Hodgkin’s disease.”
The last few words had the effect of an icy shower. Mrs. Edwards almost freaked out. Three years ago she received a similar call about her husband and the news was not good. He had cancer. Now this.
“Darling, Dr. Nebley wants you to have a biopsy. He made an appointment with a surgeon for you tomorrow,” this time she couldn’t contain her apprehension and Jennifer sensed it. She was a smart girl and, furthermore, she had enough sense to know that something could be seriously wrong. As a good student with an inquisitive mind, she set out to research the condition and find out as much about it as possible. She decided to go online and to do a Google search. What she found was not pleasant. Hodgkin’s disease is a cancer of lymph nodes; lymph nodes work like traps to encase foreign bodies and swell in case of infection. In Hodgkin’s disease, they get enlarged for no apparent reason and cause all sorts of problems. It is seen in young people around her age and in older people in their late fifties. The good part about it is that it is curable when caught on time, but the treatment can cause sterility. Regardless, this was something she would rather not have, a problem she wished would go away and leave her alone so she could enjoy life, go on more dates with Rich.
The next day, Wednesday, she went to see the surgeon. He also carefully examined her and went over the lab results. “This is a fifty-fifty proposition and only a biopsy can help make the final diagnosis.” It was scheduled for the day after next, Friday, the same day she was supposed to go on a date with Rich again.
“Hi Rich, this is awful. I have to have a procedure done in the morning and I am afraid,” Jennifer said on the phone.
“I am sorry to hear this. What exactly is it and why do you have to have it done?”
“It is called a biopsy; the surgeon will remove one of the lumps that I told you about and he will send it to the lab for analysis. I hope it is not cancer. I am really frightened.” Instead of moral support, an eerie silence followed. This was an awkward moment with neither party quite knowing what to say next. Finally, Jennifer broke the silence. “I think it will be all right. Very likely we must call off the date tomorrow but give me a call and we will talk some more. Love you darling.”
“Me too darling,” a reply not so convincing; it didn’t have the resonance of sincerity.
Jennifer’s chest felt a thump about this, a very unsettling sensation and insomnia later that night to boot. All sorts of ideas were going through her mind. She couldn’t help but think how swift the change in her life had been in a matter of one week. One week ago, her main concern was the date with her beau boo. Fantasy of canoodling occupied her mind. Now her very life consumed her; her very survival at the tender age of seventeen suddenly came to the fore as a very important matter. Somehow, she couldn’t understand it. Rich’s behavior was on her mind; his cold response to the biopsy was not a good sign. She had observed a subtle change in his enthusiasm from the time she told him the following day that she would go to see a physician because of “enlarged lymph nodes.” That subtle change had abruptly morphed into an uncomfortable distancing. None of that bodes well for the relationship, she kept thinking all the while hoping she was just overreacting.
On Friday in the morning, she went to the hospital, to the “Same Day Unit.” This was her first ever encounter with a health care institution. A clerk asked her and her mom to fill out a form that included a lot of questions about her past health history. The clerk dutifully recorded insurance information. She met and gawked at a long document called a “Consent Form.” It basically gave permission for treatment and mentioned possible complications from the procedure, including infection, bleeding. Under ordinary circumstances, her instinct would pulse her to read every single line and ask as many questions as possible. Now sweating, her hands uncontrollably shaking and not willing to dwell with a negative outcome, she indulged her mother to sign on the spot without any asking questions.
“Please follow me to this room and this is a gown you need to wear and disrobe.” The room was a bed behind a curtain, next to a few in a row. “Let me attach this bracelet.” In a second, the clerk attached a paper bracelet with her name, date of birth, her doctor’s name and the hospital insignia clearly delineated. All of this was so strange to her. A nurse came in later and basically went over the information supplied, asking some additional questions like any history of allergy(ies), any previous illness or biopsy. She then started an IV (intravenous) line. “You will be fine. We will take you to the OR (Operating Room), next,” the nurse stated politely but nonetheless in a matter-of-fact way that reeked a bit of an automatic recitation. Everything seemed to happen so fast; she kept looking at her phone hoping to see a text from Rich; it wasn’t to be. She couldn’t help but notice a worried look on her mom’s face. That made her lips quiver, the thumping sensation accelerate, and the shaking of the hands grow in intensity. “Darling, everything will be all right. I will stand by you.” Such simple words went a long way toward calming her. Nonetheless she wished they had come from Jeff’s lips. This was a very strange experience.
Everything seemed to be down to a science by the staff. Every person was polite but one sensed that they were seeing so many sick patients that they have acquired some immunity to the concept of illness. It occurred to her that unless one was sick, it was hard to imagine what it was like. She, for one, never gave it a thought till now. Good health was something that everyone took for granted until illness comes to visit. Illness is a condition that makes others uncomfortable. Her last conversation with Rich was a proof of that. His knee-jerk reaction was an unpleasant surprise bordering on fear; fear of catching something, fear of being next to a sick person, fear of the idea that one’s physical body was very fallible and susceptible to maladies. She needed to get accustomed to the notion herself. She didn’t know how she would have reacted had the situation been reverse, i.e., had Rich been the sick one. She also began to wonder about what would happen to her if she did have this Hodgkin’s stuff. What would happen to her plan of graduating and going on to college? Would she become sterile and not have any kids of her own? Will she go on anymore dates with Rich?
She was deep into all of this introspection when an orderly finally came and informed her and her mom that she was taking her to the OR. She felt a knot in her throat. The surgeon did explain that this was a straightforward procedure and she will leave and go home right after it. The very idea that she needed to have the procedure done was still unsettling. It meant that there was a very real possibility that something could be seriously wrong with her. She was still in her thoughts and didn’t hear her mom’s words of “Good luck, I love you my dear.” She had her eyes closed and only opened them when wheeled into the OR suite. An anesthesiologist came in and introduced herself. “I am going to give you this medication to put you to sleep,” he said calmly.
She did look and she saw a white liquid in a tubing; it felt slightly warm as it penetrated her vein. “Ok, it’s all over and you can wake up.” Jennifer was in this betwixt and between world of drowsiness and wakefulness. She felt a bit groggy and noticed a small bandage on her neck; it was the site of the biopsy. A sinking feeling engulfed her. This was real. She did have the procedure done. Now she had to wait for the result and deal with the consequences. The groggy feeling dissipated steadily, and she went back to her room.
“My darling,” said her mom while kissing her on the cheek.
The staff gave Jennifer a sandwich and some apple juice along with a banana. She did not even notice that she had yet to eat for the day. Her normal good appetite was absent. She had a heavy heart.
“How do you feel?” Reassuring though her mom’s voice was, the very need for the question meant an abnormal situation was at play. Instead of calming her nerves, she began thinking about this “disease.”
The best she could come up with was a wry smile. The only thought that kept recurring was the idea of being potentially sick with cancer. It mattered not that the book stated that it could be cured. What mattered was the existence or the potential for the existence of the condition. She couldn’t yet come to terms with this notion. No matter what was said to her, she was feeling on pins and needles about her situation. She could have a cancer. This was so dreadful, anyway one looked at it. She was usually ebullient, talkative. Today she has been quiet, in a morose mood. Her mom noticed it and this saddened her. When her child was sick, so was she. When her child was sad, so was she. She tried to reassure her. She passed her hand over her forehead in a gentle fashion. She tried to help her get dressed and kept smiling whenever possible, but she knew that her daughter was not in the best mood today. She did not know what else to do. Her natural tendency was to try and keep trying.
Jennifer finally broke down and started crying. “Why me?” she asked. (To continue).
Reynald Altéma, MD